A caretaker for a senior with CLL is
often much more than a conduit to appointments and drugs. Many caregivers want
to know why a particular drug is being prescribed, what other options there are
and how the various treatments will impact the person with CLL in their daily
lives.
There are many new treatments being given
to people with CLL. Many of these are being used as targeted treatments. They
may be used alone or in various combinations, depending on the patient and
disease characteristics. Despite availability of multiple new treatments, there
are many factors that must be taken into consideration to choose the
appropriate treatment option.
Chronic Lymphocytic Leukaemia or CLL is a
form of blood cancer characterized by presence of abnormal lymphocytes. These
are a type of white blood cells which, in people with CLL, slowly start to
multiply in the blood, in the bone marrow where all the blood cells are
produced, and in the lymphatic system of tissues and organs throughout the body.
It tends to develop in middle aged or older people.
However, the majority of individuals with
CLL are asymptomatic at the time of diagnosis and are therefore monitored on an
active surveillance or watchful waiting basis until such time as the disease
progresses and requires treatment.
In summary, while there are times when
CLL needs to be treated, there are also times when regular monitoring is
enough. When there are signs of progression, or symptoms, then treatment may be
indicated. At that time, enlarged lymph nodes, and low blood counts, as well as
fatigue, night sweats, unexplained weight loss, and fever, can be symptoms
which indicate the need for treatment.
Two people of the same age have very
different physical, mental, social and financial circumstances. Hence treatment
decisions are based on more than age of patient.
For an older adult, clinicians may
consider:
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Overall physical health and
functional ability
●
Other medical conditions and
medications
●
Kidney and liver function
●
Blood-cell counts
●
CLL stage and rate of progression
●
Genetic findings, including TP53
abnormalities and del(17p)
●
Previous CLL treatment
●
Risk of infections and other
treatment-related complications
●
The person's preferences and
ability to manage treatment
Geriatric assessment is done to evaluate
physical function, cognitive status, nutrition and social support to aid cancer
treatment decisions.
The assessment for a geriatric patient
with CLL will likely differ greatly from that of a younger patient with the
same diagnosis. The results can help the patients and caregivers in evaluating
treatment options.
Treatment for CLL is increasingly moving
towards targeted therapy using a medicine that in turn uses a particular
protein to kill CLL cells.
The Bruton tyrosine kinase (BTK)
inhibitors are a class of targeted therapy for CLL.
Examples include:
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Acalabrutinib
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Zanubrutinib
●
Ibrutinib
These types of therapies can inhibit the
BTK protein and other related proteins which affect the B-cell in terms of
development and in the CLL cell in terms of survival.
Additionally, while latest CLL treatments are
administered via oral tablets or subcutaneous injection rather than via an IV
line and infused into a vein over hours, these novel oral therapies can cause
significant side effects and have drug-drug and drug-food interactions,
requiring the monitoring of such issues as the patient’s blood counts, cardiac
function, risk of bleeding, risk of infection, and other treatment-related
adverse effects.
Venetoclax is a BCL-2 targeted therapy.
BCL-2 is a protein that certain cancer cells use to survive. The most common
use of Venetoclax in CLL is in combination with other therapies such as
obinutuzumab and rituximab.
Venetoclax is being given in a new manner
in order to decrease the risk of developing TLS (Tumor Lysis Syndrome) during
the early dose-escalation period of treatment. Normal laboratory values and
gradually increasing doses of venetoclax will be a cornerstone of its early
administration.
Caregivers should be especially vigilant
in following a treatment plan that involves a monitoring schedule for a
treatment like venetoclax.
The CLL treatment landscape has evolved
significantly in recent years. For example, in February 2026 the U.S. Food and
Drug Administration approved acalabrutinib in combination with venetoclax for
CLL treatment.
Targeted treatments are designed as per
patient and disease characteristics. Approval of a combination of cancer drugs
by the FDA does not automatically mean that it will be the an appropriate
treatment option for a particular patient with CLL. Rather, it will be one of
the many considered for an individual patient on the basis of their disease,
medical history, other drugs that they are taking, how they tolerate individual
drugs, and their preferences.
Even after treatment has seemingly been
effective, CLL can return at a later time, and treatment options that are
relevant for patients with relapsed CLL are largely based on the prior
treatments that have been used.
Pirtobrutinib is a non-covalent BTK
inhibitor. Recently, pirtobrutinib was approved by the FDA for the treatment of
adults with CLL or SLL who have had prior treatment with a covalent BTK
inhibitor.
There are many other treatments,
including new targeted therapies and treatment combinations, that are being
investigated for patients with CLL that has become resistant to treatment.
These are often investigated in the context of a clinical trial.
Just as every person with CLL is
different, so too is every person’s CLL. The differences can be in terms of the
individual’s prognosis and in terms of the choices for treatment. Certain
genetic and molecular features of the cancer can affect both.
Among the key findings that can guide
treatment decisions for CLL patients are TP53 abnormalities and deletion 17p
(del(17p)). These can mark a more aggressive disease that is harder to treat
with standard CLL therapies.
A patient’s genetic makeup can influence
treatment options during the treatment, or even before starting the treatment.
Caregivers play a vital role for elderly
patients during treatment for CLL and can monitor for changes and report to
clinicians if needed.
Depending on the treatment, clinicians
may monitor:
●
Blood-cell counts
●
Signs of infection
●
Bleeding or bruising
●
Heart-related symptoms
●
Kidney function
●
Liver function
●
Medication interactions
●
Treatment-related fatigue or other
side effects
A list of the patient’s prescription
medicines, over-the-counter products, and supplements can be maintained by
caregivers. These can potentially cause an interaction with the treatment of
the patient.
Caregivers must report new or unusual
symptoms to the treating healthcare team.
Useful questions for the CLL Care Team
appointment.
●
Does the CLL currently require
treatment?
●
What is the goal of treatment?
●
Which treatment options are
appropriate for this patient?
●
What test results influenced the
treatment recommendation?
●
Has genetic testing been
performed?
●
What side effects should the
family watch for?
●
Which symptoms require urgent
medical attention?
●
Are there interactions with the
patient's existing medicines?
●What should be the frequency
of blood work check and monitoring?
●
Are clinical trials appropriate?
Written notes can also be helpful to
record information that the family needs to remember in order to follow the
instructions given by the CLL Care Team, as well as remembering the dates and
times of the family’s and patient’s future appointments for treatment and
check-ups.
Finally, CLL care includes more than
leukemia control. Patients, especially of advanced age, often suffer from a
variety of problems including frequent infections, decreased appetite and
subsequent weight loss, extreme tiredness, depression, decreased mobility, and
other co-existing health problems.
Supportive care to treat symptoms and
problems of CLL can vary greatly from person to person. The caregiver
needs to report any change in the patient’s physical condition or in their
daily functioning, such as loss of appetite, or lack of energy, etc.
Current CLL treatments include targeted
therapies, BTK inhibitors, and venetoclax-based combinations, as well as newly
approved treatments for relapsed or refractory CLL, such as new agents for
previously treated patients like pirtobrutinib, which was recently granted a
traditional approval for a specific subset of previously treated CLL patients.
For older adults, the most appropriate
treatment depends on individual patient and disease characteristics and may not
necessarily be the latest treatment option. Individualized management of CLL,
taking into consideration the patient’s specific leukemia, previous treatment,
other health problems, other current diseases, potential drug toxicities and
patient preferences is typical.
These forms of support can help
caregivers play an active role throughout the treatment process
Medical disclaimer: The purpose of this article is for general information and for
education purposes only. The CLL treatment of individual patients has to be
decided by their qualified healthcare providers after thorough examination of their
disease, overall health, as well as other coexisting medical conditions.
Passions Grow, Passions Bloom: Cultivating Wellness at Willow Valley Communities Among the most popular passions at Willow Valley Communities is gardening. And, Residents here have a wide variety of ways to indulge. Three generous gardens are situated across our sprawling 210-acre campus for Residents to use in a multitude of configurations of their choosing. Willow Valley Communities hardworking Grounds Team tills each garden in the spring and plows them in the fall, making them ready for Residents to dig right in. Whether Residents are experienced pros or novices, gardening is a wonderful way for them to get outside, enjoy nature and each other, and learn new things. Some Residents have been gardening for decades, while others have only started gardening after moving to Willow Valley Communities. In keeping with our Life Lived Forward philosophy, some Willow Valley Communities Residents take their love of gardening to deeper levels. For example, several Residents from across the country have achieved the distinction of Master Gardener. Master Gardeners are certified in their home state, and the program can take six months to a year to complete and includes a minimum of 40 hours of classroom training, a score of 80 percent on the final exam, and 50 hours of volunteer service. In another example, Residents Annabelle Simpson and Susan Kelly worked with the Penn State Extension of the Pennsylvania State University to have one of their gardens certified as an official Pennsylvania Pollinator-Friendly Garden. The stunning garden is well-known for attracting huge numbers of bees, butterflies, insects, and birds, helping our ecosystem to thrive. Residents are also able to partner their gardening skills with their desire to volunteer and give back to the Lancaster community. With the areas rich, fertile soil, and the extra special care and attention the plants receive, Residents often have an abundance of vegetables and donate them regularly. Throughout the growing season, the Solanco Neighborhood Ministries food bank receives a variety of beans, lettuce, kale, peas, carrots, eggplant, cucumbers, peppers, tomatoes, spinach, and much more from Willow Valley Communities Resident gardens. Additionally, every fall, a harvest of hundreds of pounds of sweet potatoes and butternut squash goes to the Lancaster County Food Hub, a community resource for free, nutritious food and gently used clothing. Some Residents maintain gardening plots every year just for this purpose.Annabelle Simpson and Susan Kelly Gardening time is couple time for Residents Mike and Susan Ziegler. Sue is an avid gardener, and Mike loves being outdoors supporting her gardening passion at Willow Valley Communities. They both love being together in nature, and Sue is amazed by how magical gardening can be. Its just a miracle when the seeds come up, she says. Resident Pat Mortensen challenges herself every year by growing something completely different. Once she enjoyed a robust harvest of King Tut Purple Peas, a very rare garden pea said to have been taken out of the tomb of King Tut! Resident and Master Gardener Angela Booker-White is originally from Virginia but has lived all over the country. Her interest in gardening grew as she read and learned more about it. In her plot at Spring Run, Angela grows all sorts of fruits, vegetables, and flowers and always tries something new. She has the most success with seeds she purchases from the dollar store! Angela has also learned how gardening can help during challenging times. She is grateful to her garden, as well as to her fellow Willow Valley Communities gardeners, for helping her during the difficult time of her husbands unexpected passing. Gardeners, and she doesnt know exactly who, would come and help by doing extra work around her plot. Residents just came in and helped, Angela says. Weeding, cutting, trimming, harvesting whatever work needed to be done. Thats the way Residents are here at Willow Valley Communities: very supportive. Resident Keith Yoder, who coordinates the Spring Run Garden, is not at all surprised by the variety of gardeners at Willow Valley Communities or by the reasons they enjoy the activity so much. He agrees that gardening is definitely a hobby that enhances well-being. Though hes known this himself for years, he refers to an article put out by CNBC that states how gardening can add years to your life. And life to your years, Keith adds. Gardening gets you into nature. Its good exercise for your body and your mind plus, you get to eat what you grow!
The Willow Valley Communities Day Spa is a destination for wellness and renewal. Its a critical component of the comprehensive Mind, Body, Spirit approach to wellness of Willow Valley Communities. The Day Spa offers many ways to soothe, calm, invigorate, or rejuvenate. A full range of professional services, all performed by our attentive and inviting staff, allows Residents to create their own regimen for personal well-being and beauty. These services include manicures and pedicures, skin care, facials, revitalizing peels, waxing, tanning, microdermabrasion, and body treatments with a wide range of different massage modalities, wraps, and scrubs. The Relaxation Room, with its beautiful waterfall and Himalayan Salt Wall, is a main feature of The Day Spa. It provides a peaceful and well-appointed environment in which to relax and offers a perfect and welcome respite between services. Himalayan salt rich in negative ions and essential nutrients and minerals offers numerous health benefits for our bodies, such as stress reduction, energy increases, and mood boosts at a biochemical level. Day Spa Manager Diamando Wallace says, Self-care is essential. Although manicures and pedicures are a well-deserved treat, they offer so much more to Residents sense of well-being. You can see the boost in a clients self-confidence as they walk out feeling refreshed. Massages are one of the most popular services requested by Residents, and The Day Spa offers a wide menu of options, including hot stone and aromatherapy. Emily Ransing, Willow Valley Communities Day Spa Massage Therapist, says, Massage is meant to enhance your well-being physically and mentally. I frequently remind my clients that this is their time to focus on themselves to feel healthier. I do all I can to send each client home feeling better than when they arrived. A Willow Valley Communities Resident was asked about her massage as she was leaving The Day Spa one afternoon. She said, After a massage with Emily, your body is so relaxed that you can focus on the things that you often overlook the air is sweeter, the birds are more melodious, the day is brighter. You are better equipped to face the next days, whatever they may bring. As she walked out of the Cultural Center to her car, she added with a smile, Its also a way to take the tension out of your body although theres not much tension at Willow Valley Communities!
When headaches are chronic, it can be hard for you or your loved one to work, socialize, exercise, read, or engage in other meaningful activities without treatment. Constant or frequently recurring pain can make it harder to function over time, decreasing quality of life. Chronic headaches also may indicate an underlying medical condition that could be serious if left untreated.Recognizing warning signs and understanding potential causes of headaches can help seniors and their loved ones get a diagnosis and incorporate effective headache management strategies to relieve pain and live more comfortably.What Are Chronic Headaches?Chronic headaches occur 15 or more days per month and can stem from muscle tension, stress, fatigue, and other factors, leading to throbbing temples, a stiff neck, watery eyes, and eye strain.Types of Chronic HeadachesChronic headaches can occur for different reasons and may vary in intensity, duration, and symptoms. Understanding the type of headache you or your loved one is experiencing can help you find the right treatment and prevention strategies.Here are some common types of chronic headaches: Tension headaches: Stress and muscle tension in the neck and scalp trigger these headaches. Cluster headaches: Sudden-onset pain on one side of the head for short periods that then repeats several times daily. Medication-overuse headaches: Caused by taking headache-relief medication too often, which can change pain pathways in the brain. Caffeine-withdrawal headaches: If you drink beverages with caffeine on a regular basis, quitting suddenly can cause a headache Dehydration headaches: When you dont drink enough water, it can affect your blood pressure, blood flow, and pain receptors, causing headaches Sinus headache: A sinus infection or severe allergies can cause pain or pressure in the head. Chronic Headaches vs. MigrainesThough often conflated, chronic headaches and migraines are different conditions. The main difference is that a migraine is more severe with pulsing or throbbing pain on one side of the head that can last for hours or days. Migraines are typically triggered by hormones, weather changes, certain foods, sleep disturbances, and stress.While there are several types of migraines the most common are: Migraine without aura: Typical migraine pain, such as throbbing or pulsing on one side of the head, nausea, and sensitivity to lights, sounds, and odors. Migraine with aura: Typical migraine pain preceded by a migraine aura which can include neurological symptoms like dizziness, vision changes, numbness or tingling, tinnitus, or not being able to speak clearly. What Causes Chronic Headaches in Older Adults?Chronic headaches in older adults are usually caused by lifestyle factors, such as stress, poor sleep, too much caffeine, dehydration, poor posture, physical inactivity, and more. Family history of chronic headaches or migraines can also contribute.Additionally, seniors are more likely to develop chronic health conditions with age, which may lead to chronic headaches. For example: Unmanaged high blood pressure can trigger hypertension-related headaches. People with diabetes are more prone to migraines, and poorly managed blood sugar levels can cause headaches. Untreated sleep apnea makes it hard to sleep well, increasing the risk of headaches. Arthritis pain that alters posture can lead to tension headaches. Ignoring vision loss can lead to headaches from eye strain. Withdrawal symptoms of alcohol dependency can include severe headaches. When a Headache Signals Something More SeriousSerious conditions that can cause headache-related symptoms include stroke, hypertension, and traumatic brain injury (TBI).If youre wondering when to be concerned about headaches, consider these factors: Does the pain keep coming back? Are headaches paired with nausea, vomiting, or sensitivity to light or sound? Do you see visual disturbances, such as an aura, flashes of light, or blind spots? Are you experiencing dizziness or balance problems? Do you have a stiff neck, fever, nausea, and vomiting? Did symptoms start after a fall or a bump on the head? If headaches are associated with the following symptoms, seek emergency care: A sudden, intense headache The worst headache of your life Extreme dizziness or confusion Numbness or weakness in your extremities Head pain after a car accident, fall, or other head injury Slurred speech How to Manage & Prevent Chronic HeadachesIt isnt possible to prevent every headache, but you can work to reduce their frequency and severity. These strategies can help you or your loved one manage chronic headaches: Adopt healthy lifestyle habits, such as staying hydrated all day, eating nutritious foods, and getting enough sleep. Manage stress with mindfulness meditation or other relaxation techniques. Maintain a regular fitness routine that includes senior-friendly cardio and mobility exercises. Be sure to consult your doctor before beginning a new exercise program. When headache symptoms become too severe to handle alone, consider these options: Medications: Over the counter (OTC) or prescription pain relievers may help ease symptoms. Before taking any new medication, ask a healthcare provider or pharmacist about potential drug interactions and proper usage to reduce the risk of medication-overuse headaches. Physical Therapy: If tense muscles or poor posture are contributing to headaches, physical therapy can provide simple exercises, stretches, and posture training to alleviate pain. Geriatric Massage: Massages specific to senior needs can reduce stress, loosen tight muscles, and improve mobility to address pain. Frequently Asked Questions About Chronic HeadachesHow can I tell if a headache is serious?A headache is serious if it comes on quickly, causes extreme dizziness or confusion, leads to numbness or tingling in extremities, and/or occurs after a fall or injury to the head. If you or a loved one is experiencing any of these symptoms, seek immediate medical care.Whats the difference between a chronic headache and a migraine?A chronic headache is defined as mild to severe head pain occurring 15 or more days per month. Chronic headaches can be caused by muscle tension, stress, caffeine withdrawal, dehydration, sinus infections, and more.A migraine is more severe head pain that lasts anywhere from a few hours to a few days thats felt on one side of the head along with nausea and sensitivity to light, sound, and/or odor. Migraines are categorized by with aura or without aura and can be caused by hormonal changes, shifts in the weather, poor sleep, stress, and more.How can I support someone with frequent headaches or migraines?If your loved one experiences frequent headaches or migraines, there are many ways you can support them. You can encourage them to get plenty of sleep, maintain healthy eating habits, stay physically active, and focus on reducing stress. Additionally, you can recommend that they speak with their healthcare provider about headache or migraine treatments.When should in-home care be considered for headache management?If you or a senior loved one struggles with completing activities of daily living (ADLs) such as bathing, grooming, or eatingdue to severe or chronic headache symptoms, in-home care can be a helpful solution. Professional caregivers and nurses can assist with senior health goals and proper medication usage at home, while also providing emotional support and companionship.